Golden Bear Pass Program Application 2022 (DPR 578 ...

State of California - Natural Resources Agency DEPARTMENT OF PARKS AND RECREATION. Golden BEAR PASS Application . 2022 Calendar Year (January - December) - Application Fee Waived To qualify for the Golden Bear Pass, the applicant must currently receive Supplemental Security Income (SSI), OR receive aid under the CalWORKs Program (as defined below), OR be 62 and over and meet certain income limits. A. Personal Information: CHECK IF APPLYING TO REPLACE A LOST/STOLEN PASS FROM THIS CALENDAR YEAR. APPLICANT NAME (Last, First, Middle Initial)(Photo ID required) SPOUSE / REGISTERED DOMESTIC PARTNER (Photo ID required if named on pass). PHONE NUMBER DATE OF BIRTH E-MAIL ADDRESS. MAILING ADDRESS / CITY / STATE / ZIP CODE. HOME STREET ADDRESS / CITY / STATE / ZIP CODE (no post office boxes) Same as Mailing Address APPLICANT ORIGINAL SIGNATURE (E-SIGNATURES AND PHOTOCOPIES NOT ACCEPTED) VALID DRIVER LICENSE/OTHER PHOTO ID NO.

DPR 578 (Rev. 12/2021)(Excel 12/17/2021)(Page 1 of 3) DO NOT DUPLICATE APPLICATION - DEPARTMENT LEGAL OFFICE SHOULD BE CONSULTED BEFORE DISCLOSURE. A copy of a valid state issued driver license or photo identification (interim/temporary not accepted) issued by the state or federal government, or a current school ID.

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